In mid-March 2020, it was communicated to hospitals via the HTSC Committee that all non-essential care had to be suspended. Particular attention had to be given to surgical interventions that had an impact on bed occupancy for the ‘Intensive Care’ function.
This decision was made for several reasons:
- To relieve the intensive care units;
- To free up health care providers to care specifically for COVID-19 patients;
- To optimise the use of medical equipment;
- To reduce the use of protective equipment which was scarce at the time.
Naturally, urgent and necessary care continued as before. In early May 2020, it was communicated that the restart of plannable, non-urgent care could be implemented in phases under strict conditions. Each hospital was required to maintain the capacity to treat patients from the first wave, and be ready to receive patients from the second wave. Furthermore, organisational measures were taken to avoid crowding, and ensure physical distancing between patients.
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The following phases were formulated for the restart of these activities:
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In preparation for restarting care, the Federation of Belgian Professional Associations of Medical Specialists drew up a reference framework on the necessity and urgency of care that can serve as an orientation tool for doctors.
Find out more about this reference framework: www.vbs-gbs.org
In the period leading up to the second wave (autumn 2020) these phases were reversed. Necessary and urgent care could take place as always. Furthermore, efforts were made to allow non-essential care to continue as much as possible. During the third wave (spring 2021), it was once again necessary to defer non-essential care. In this phase, hospital managers were asked to estimate which care could continue or not, depending on the specific situation. In the subsequent waves, hospitals were once more asked to show solidarity. They were also expected to provide the required bed capacity. If the hospital met these conditions, it could determine itself which activities had to be postponed.
As a result of the measures, in the first wave we observed a 94% reduction in surgical care classified as non-essential. We also observed that 57% of essential surgical care continued compared to what would be expected. In the second wave, we saw a 66% reduction in non-essential surgical care and a 20% reduction in essential surgical care. The reduction in essential surgical care illustrates the impact of the COVID-19 pandemic as well as the reluctance of patients to request the necessary care.
In 2021 and 2022, we observed a relatively limited fall in rates of care provided. The recovery activity in between is higher. During the third wave in April/May 2021, care provision dropped to a maximum of 87.5%. Here, for the first time, the drop in non-essential surgical care provision is comparable to or less pronounced than for essential and mixed care. During the fourth wave in November/December 2021, the drop was most pronounced for mixed surgical care; this dropped to 89.7% of the normal expected level. This equated to a reduction of 10.3%. In the period February to March, June and September 2021, there were some months with quite strong recovery activity, especially of non-essential surgical care, up to 10 to 14.5% above the estimates on the basis of the activities in pre-COVID-19 times (black 100% line). We see the greatest recovery activity mainly in non-essential surgical activities. This is not what we would expect based on medical prioritisation. In December 2021, however, we see the greatest recovery of 12% in essential surgical care. Between waves 5 and 6, we again observed that non-essential supplies show the greatest recovery.
EVOLUTION OVER TIME OF THE NUMBER OF
PROVIDED NON-COVID HEALTHCARE SERVICES [1]
OVERVIEW OF DISTRIBUTION PLAN MEASURES AND POSTPONEMENT OF NON-ESSENTIAL CARE AND CHANGE IN NUMBER OF COVID PATIENTS
[1] Source: https://www.riziv.fgov.be/fr/themes/qualite-soins/Pages/Covid5L2FR/Covid5L2FR.html
The black line shows an advanced estimate of the expected amount of care provided based on 2019 data. A classification was made according to surgical interventions regarded as non-essential, mixed and essential. The mixed category includes provided care which, depending on the context, could be either essential or non-essential.